Comprehensive Health Insurance Plan of 1991

Summary

Comprehensive Health Insurance Plan of 1991 - Title I: Employer-Provided Health Insurance - Amends the Social Security Act to add a new title XXI under which employers are required to offer to their eligible employees a health plan that provides for basic health benefits and meets certain requirements for certification as a qualified employer plan (plan). Provides that the offer of enrollment in a plan shall include enrollment of the family of the eligible employee. Sets forth enrollment rules in cases of multiple employers. Outlines provisions concerning enrollment timing, period of coverage, and employer plan cards. Details certification procedures. Requires a plan to provide for basic health benefits. Provides that such benefits shall generally consist of the same benefits as described in title XVIII (Medicare) to an individual entitled to benefits under part A (Hospital Insurance), and enrolled under part B (Supplementary Medical Insurance) of Medicare, plus additional specified benefits including well-child care, cancer screening, and prescription drugs. Places limits on exclusions and coverage standards for basic benefits. Provides limitations for employee premiums, deductibles, and copayments as well as for out-of-pocket expenses with respect to items and services provided under a plan offering basic benefits. Permits a plan to provide for employee cost-sharing amounts that are lower than those specified if it contains such cost containment arrangements as described by the Secretary. Permits a plan to provide for supplemental health benefits. Provides that if a plan provides for such benefits and the eligible employee may not elect to forego such benefits, the plan: (1) may not impose a premium, for basic and supplemental benefits, that exceeds the premiums that may be imposed for the basic benefits; and (2) shall assure that cost-sharing is not imposed with respect to basic benefits once the cost-sharing limit has been reached in a year with respect to all benefits. Sets forth requirements relating to coordination and portability of health coverage under qualified employer plans. Preempts certain State requirements with respect to plan benefit and coverage rules and utilization review programs. Authorizes the Secretary of Health and Human Services to award grants to qualified small employer purchasing groups to assist such groups in paying the expenditures associated with the formation and initial operations of such groups. Sets forth grant eligibility criteria. Authorizes appropriations. Requires each State to establish rules governing the approval of the operation of an entity as a small employer purchasing group in such State. Sets forth rule requirements. Provides that, in the absence of any State action to establish such rules, the Secretary shall promulgate rules, including application forms, for the approval of entities to operate as small employer purchasing groups in such State. Requires each entity desiring approval to operate as a small employer purchasing group in any State to submit an application to such State. Establishes Federal standards for imposition on insurers which issue or offer qualified employer plans to small employers. Amends the Internal Revenue Code to impose an excise tax on: (1) employers who fail to offer to enroll eligible employees in qualified employer plans; and (2) insurers which do not meet the Federal standards established above by this Act. Sets forth special rules for the application of such taxes. States that the provisions of new title XXI shall not apply with respect to an employee who is not a resident of one of the 50 States or the District of Columbia. Title II: Health Care Coverage For Individuals Not Otherwise Covered Under Qualified Employer Plans or Medicare - Amends title XIX (Medicaid) of the Social Security Act to extend Medicaid health care coveragae (excluding long-term care services) to individuals not otherwise covered by qualified employer plans or Medicare and whose income does not exceed 240 percent of the official poverty line applicable to a family of the size involved. Gives States certain flexibility in providing benefits and coverage to such individuals. Provides an increase in Federal payments to States enrolling such individuals in coordinated care plans. Provides that there may be imposed premiums, deductibles or other cost sharing with respect to such individuals with family income over 100 percent of the official poverty line on a sliding-scale basis as long as such requirements do not exceed the applicable limitations specified in new title XXI of the Social Security Act. Permits buying-in to Medicare for certain uninsured individuals. Title III: Health Care Access - Tax Provisions - Amends the Internal Revenue Code to allow, in the case of an eligible small employer, as a refundable credit against any income tax imposed for the taxable year, an amount equal to 50 percent of the qualified health care costs paid by such employer during the taxable year. Sets forth special rules for the application of such tax credit. Doubles the health insurance credit and increases to 8.57 percent the phaseout percentage with respect to such credit. Repeals certain earned income tax credit interaction provisions. Provides a full deduction for health insurance costs of self-employed individuals. Makes such deduction permanent. Title IV: Administrative Provisions And Report - Amends part A (General Provisions) of title XI of the Social Security Act to: (1) require the Secretary, to the extent practicable, to develop and implement a universal health identification card and uniform claims form and reporting standards for use under Medicare, Medicaid, and new title XXI; (2) authorize additional funding for outcomes research and practice guidelines; (3) make January 1, 1993, the deadline by which the Secretary must assure the development of an initial set of specified guidelines; (4) require such guidelines to include treatments or conditions that account for a significant portion of national health expenditures (including expenditures under Medicare and Medicaid); and (5) reduce from 70 to 50 percent the amounts to be appropriated for FY 1993 and 1994 from specified trust funds. Directs the Secretary to submit a report to specified congressional committees providing information with respect to: (1) access to health care services, including the effects on access of patterns of utilization, supply and distribution of services and providers, and demographic changes; (2) sources of significantly changing health care costs; (3) the effects on costs of: (a) utilization by service, region, provider type and payer; (b) supplies, labor, capital, and new and emerging technology; (c) State and private efforts to contain such costs; and (d) outcomes research and practice guidelines; and (4) such other matters as the Secretary may consider appropriate.

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2 official files

• Introduced in Senate (text)

  Introduced in Senate · EN

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• Introduced in Senate

  summary · EN · 26 November 1991

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